Premenstrual Dysphoric Disorder

About Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder is a severe form of premenstrual mood disturbance that DSM-5 placed in the depressive disorders chapter in 2013. In most menstrual cycles during the past year, at least five symptoms appear in the final week before the onset of menstruation, start to improve within a few days after menstruation begins, and become minimal or absent in the week after. At least one symptom must be marked mood swings or sensitivity to rejection, marked irritability or anger, markedly depressed mood or hopelessness, or marked anxiety or tension. Other symptoms include reduced interest in usual activities, difficulty concentrating, fatigue, appetite changes or food cravings, sleep changes, feeling overwhelmed, and physical symptoms such as breast tenderness, bloating or joint and muscle pain. Symptoms cause significant distress or interfere with work, school or relationships, and the diagnosis is confirmed with prospective daily symptom ratings over at least two cycles. PMDD is distinguished from the milder and more common premenstrual syndrome by its severity and the prominence of mood symptoms. It is thought to involve an unusual sensitivity of brain systems to normal fluctuations in reproductive hormones rather than abnormal hormone levels. Treatments with evidence include SSRIs, which can act relatively quickly in this condition, certain oral contraceptives, and cognitive behavioral therapy.